Polycystic ovarian syndrome (PCOS) is an endocrine disorder that can lead to infertility or difficulty conceiving. It is the most common cause of conception problems in the United States. About 5-10% of women have this condition. There may be up to 5 million women affected and it can appear in girls as young as 11 years old.
Like type 2 diabetes, PCOS may be linked to insulin resistance. Many women with PCOS also have diabetes or are at high risk for it. Over 50% of obese women with PCOS will develop diabetes or prediabetes before the age of 40 years old.
Alternatively, there may be many women with type 2 diabetes who have undiagnosed PCOS. PCOS is linked to other diabetes-related conditions, such as depression, high cholesterol, atherosclerosis, high blood pressure, and heart disease. PCOS can influence the menstrual cycle, fertility, endometrium, hormones, blood vessels, heart, and appearance (acne, excess body hair and male-pattern baldness).
PCOS in a Nutshell
The ovaries contain follicles where eggs are produced. During normal ovulation, fluid is produced and fills the follicle as an egg grows. When the egg is ready to be released, the follicle breaks open, allowing the egg to leave the follicle and travel through the fallopian tube to the uterus.
Women with PCOS lack the hormones needed for the egg to reach maturity. Male hormones called androgens are also produced that may prevent ovulation. The follicle or cyst grows and fills with fluid, but it does not break open and remains a fluid-filled cyst. Because ovulation does not occur, the hormone progesterone is not produced, which is necessary for a regular menstrual cycle.
Causes of PCOS
The exact cause of PCOS is not known, but it is felt that genetics and insulin play a part. Women with PCOS make more androgens, and this could interfere with ovulation. Insulin resistance can cause the body to produce too much insulin. High levels of insulin may cause the body to produce too much androgen.
Symptoms
PCOS symptoms may vary. Some of the following symptoms may be noted:
- Irregular, absent, painful, or abnormal menstrual cycles
- Prolonged or heavy bleeding
- Problems trying to conceive
- Pelvic pain
- Excess facial, chest, stomach, back, thumb, or toe hair
- Male-pattern baldness or thinning hair
- Acne or oily skin
- Dandruff
- Skin tags
- Apple body shape (waist bigger than hips or waist greater than 35 inches)
- Acanthosis nigricans
- Ovarian cysts
- Depression or anxiety
- Sleep apnea
Diagnosis
After getting details on your medical history, such as your menstrual cycle and reproductive history, your doctor will perform a pelvic and physical exam. You will be checked for cysts on your ovaries.
Depending on the results, your doctor may order a vaginal ultrasound for a better look at the ovaries and to check for thickening of the endometrium.
Your doctor might also order lab tests to check androgen hormone levels, as well as cholesterol, insulin, and glucose (blood sugar) levels.
Treatment
PCOS treatment is tailored individually and is aimed at preventing future problems and to increase chances for conception should you want to become pregnant. The goals are to lower glucose levels and maximize your body's use of insulin (therefore reducing insulin levels).
Depending on your needs, treatment can include:
- Healthy low-carb diet, regular exercise, and weight loss
- Smoking cessation or avoidance
- Birth control pills to clear acne, reduce male hormone levels, and control menstrual cycles
- Diabetes medications, such as metformin
- Blood pressure and cholesterol medications, if needed
- Bariatric surgery (might be an option for morbidly obese women)
- Medications to help with cosmetic effects
- Emotional support for infertility, depression and appearance issues
PCOS and Pregnancy
PCOS prevents normal ovulation and decreases the chances for conception. Fertility medications (such as clomiphene or gonadotropins), steroids, low-dose aspirin, and drugs that increase insulin sensitivity may help increase chances for conception. In vitro fertilization may be an option, but has a high monetary cost.
The risk for miscarriage is increased in women with PCOS but may be reduced by improving hormone and blood glucose levels.
The type 2 diabetes drug metformin may help with fertility and also reduce the chance for miscarriage. Some doctors prescribe it during pregnancy, although the long-term effects on the baby are not known and the FDA has not approved it for PCOS treatment.
Gestational diabetes screenings should be performed earlier in women with PCOS. On a positive note, some women with PCOS find it easier to conceive again after a pregnancy.
PCOS also increases the risk for preeclampsia and premature delivery. The mother should have her pregnancy closely monitored and check her blood pressure regularly.
Sources:
Metformin. Pub Med Health. National Institutes of Health. Accessed: June 11, 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000974/
Polycystic Ovarian Syndrome (PCOS). The American Diabetes Association. Accessed: June 12, 2011. http://www.diabetes.org/living-with-diabetes/women/polycystic-ovarian-syndrome.html
Polycystic Ovarian Syndrome (PCOS). The National Women's Health Information Center. Accessed: June 10, 2011. http://www.womenshealth.gov/faq/polycystic-ovary-syndrome.cfm#a
